Definition

Chronic heart failure is a condition where the heart cannot pump blood efficiently enough to meet the body's needs. Although the heart continues to pump blood, it does not do so as effectively as a healthy heart. This condition can affect people of all ages, including children. However, the causes of heart failure in children differ from those in adults.

Causes

Around 1% of all newborns have congenital heart defects, which can vary in type. One common defect is a hole between the left and right chambers of the heart, causing oxygen-rich and oxygen-poor blood to mix. Another possible defect involves abnormal blood vessels, leading to similar mixing. These vessel abnormalities can occur in the brain or other parts of the body.

Other issues can arise from valve abnormalities. If the heart valves are not properly formed, they may not close fully, causing blood to flow backward into the chambers. Valve defects can either be congenital or occur due to infections, such as a throat infection caused by Streptococcus bacteria. Such infections can damage normal valves. Conversely, a valve may not open fully, increasing pressure in the chamber holding blood before it passes through the valve.

In children, heart failure can also be caused by anemia, viral infections that damage the heart muscle, or problems with coronary arteries that supply blood to the heart muscles. These coronary issues may be congenital or arise from infections.

Certain medications, particularly those used to treat cancer, can also damage heart muscles, leading to heart failure. Additionally, electrical issues in the heart can disrupt the heart's ability to pump blood correctly, either by slowing down or speeding up the heart rate.

Heart failure can also be caused by severe chest injuries or muscle disorders such as muscular dystrophy.

Risk Factor

Risk factors for chronic heart failure in children include problems with the heart, blood vessels, muscles, or blood, or injuries. Heart problems can be structural, such as a hole between the left and right chambers, valve abnormalities, or electrical issues. Blood vessel issues may involve abnormal formations, either in the coronary arteries or other parts of the body. Muscle problems can include damage from infections, muscle disorders, or certain medications. Prolonged anemia is another significant risk factor.

Symptoms

Common symptoms of chronic heart failure in children include:

• Swelling in the back of the feet, ankles, elbows, eyelids, and sometimes a bloated abdomen
• Rapid breathing
• Heavy breathing or shortness of breath
• Fatigue
• Nausea
• Sleeping or getting tired easily while breastfeeding or eating
• Loss of appetite
• Rapid weight gain despite reduced appetite due to fluid buildup
• Coughing and fluid accumulation in the lungs
• Shortness of breath that worsens with activities like eating, walking, or climbing stairs
• Muscle mass loss
• Difficulty gaining weight
• Changes in skin color and temperature (either pale and cold or red and overly warm)

The severity of symptoms depends on the heart's ability to pump blood. These symptoms can also resemble other medical conditions, so consulting a doctor is recommended.

Diagnosis

Chronic heart failure can be diagnosed through several tests aimed at confirming the condition and identifying its cause. These tests include laboratory evaluations, electrocardiograms (ECG), and imaging. Laboratory tests may include a complete blood count, blood gas analysis, electrolyte levels, cardiac biomarkers, and kidney and liver function tests. A complete blood count can help detect anemia, while blood gas analysis measures oxygen levels. Electrolyte tests evaluate ions like potassium and calcium, which regulate fluid balance and muscle function. Cardiac biomarkers are substances released when the heart muscle is damaged. Kidney and liver function tests check for organ failure related to heart performance.

Another examination is an electrocardiography (ECG) examination. An ECG measures electrical activity in the heart, helping detect electrical abnormalities that might cause or result from heart failure.

At the same time, imaging can be conducted to observe the heart's functionality as a pump. Imaging, such as echocardiography, uses sound waves to visualize heart function. It allows doctors to assess heart chambers' movement, valve function, and the flow of oxygen-rich and oxygen-poor blood.

Management

Treatment for heart failure in children depends on the child's age, health condition, cause of heart failure, parental preferences, and the child's tolerance to available therapies. If heart failure results from a structural issue, surgery may be needed. A pacemaker may also be used to regulate heart rhythm if electrical problems exist. Medications may be administered before or after surgery.

Common medications for treating heart failure include:

• Digoxin. Affects the heart’s electrical activity, improving heart muscle contractions.
• Diuretics. Help remove excess fluid via the kidneys.
• Potassium-sparing diuretics. Similar to regular diuretics, but also preserve potassium, an essential mineral often lost with diuretic use.
• Angiotensin-converting enzyme (ACE) inhibitors. Dilate blood vessels, making it easier for the heart to pump blood.
• Beta-blockers. Slow heart rate and lower blood pressure, improving the heart's pumping efficiency.

If the above treatments are ineffective, a heart transplant may be considered. However, heart transplants are not yet available in Indonesia due to their complexity and potential ethical, cultural, and traditional concerns.

Complications

If left untreated, chronic heart failure can lead to further heart function decline. As the condition worsens, a child's quality of life deteriorates, requiring more time and resources for care. In severe cases, it may become difficult for the child to survive.

Prevention

Preventing chronic heart failure involves avoiding anemia and treating infections. Iron deficiency anemia can be prevented by consuming iron-rich foods, such as spinach, chicken liver, meats, legumes, and dried fruits. Infection management is crucial to prevent overactive immune responses that can damage the heart or to stop infections from spreading to the heart. Throat infections caused by Streptococcus bacteria, for example, should be treated promptly with antibiotics as prescribed by a doctor.

When to See a Doctor?

If your child exhibits heart failure-like symptoms such as sudden swelling in the legs, ankles, elbows, eyelids, face, or abdomen; frequent lung infections; or difficulty growing normally, consult a doctor. If your child has a congenital heart defect, regular consultations can help prevent the condition from worsening.